POST SCENE While en route to the appropriate facility, the p…

POST SCENE While en rоute tо the аpprоpriаte fаcility, the patient starts to show signs of imminent delivery and has the urge to push. Contractions are now 2-3 min apart and last about 60 sec.  The vital signs are BP 100/62, P 128, R 24, SpO2 98% on 15 LPM with a NRB.  SCENE The patient (72kg) is walking around her living room and appears anxious. The patient states this is her third pregnancy and she is 36 weeks gestation. The patient reports her back and lower abdomen has been hurting the last few hours and there was a gush of fluid when she was doing laundry just prior to calling 911.  The patient has no prior medical history other then 1 prior vaginal birth and 1 miscarriage. Medications include ferrous sulfate and a prenatal vitamin. The patient has no allergies to medications.  The patient is apprehensive. The contractions are regular at 5-6 min apart, lasting about 30 seconds. On inspection there is no crowning but bulging of the perinium is noted. The patient obeys commands, eyes are open with equal and reactive pupils. Breath sounds are clear bilaterally. The vital signs are BP 128/88, P 118, R 20, SpO2 98% on room air, and T 98oF (37oC). The blood glucose level is 108 mg/dL. EN ROUTE The paramedic is dispatched to a residence for a 32 year old patient with abdominal and back pain. Dispatch reports that the patient is 36 weeks pregnant with twins. The time of call is 22:30 and the response time is 7 minutes. The paramedic is partnered with an EMT and the fire department is dispatched with the ambulance. It is a clear fall night and the temperature is 64oF (17oC). A local community hospital is 10 minutes away, and a comprehensive medical facility with obstetrics is 15 minutes away.